Stereotactic Body Radiation Therapy (SBRT) Combined With Transarterial Chemoembolization (TACE) in BCLC Stage B and C Hepatocellular Carcinoma (HCC)

Abstract

Due to the endoscopic screening, superficial esophageal cancer detection rate has been increasing and the rate of the patients with complex background such as superficially extended lesions, complications, history of other cancer, old age has been also increasing. For those patients, involved field radiation therapy is a good alternative. Treatment outcome of involved field irradiation for thoracic superficial esophageal squamous cell carcinoma in our hospital were retrospectively analyzed for future treatment strategies. Materials/Methods: From July 2003 to December 2014, 70 cases with T1N0M0 thoracic esophageal squamous cell carcinoma were treated with involved field radiation therapy and endoscopic evaluation after treatment. There were 61 male, 9 female, and the age ranged from 45 to 90 years old, with a median of 73 years old. Performance Status (PS) of all patients was 1 or better. The reasons for radiation therapy were comorbidities in 54 cases, broad-multiple lesions in 10 cases, and refuse of surgery in 6 cases. The invasion depths of the lesions were mucosal (M) in 25 cases and submucosal (SM) in 45 cases. Chemotherapy, mainly consisting of CDDP and 5FU, was concurrently used in 46 cases. Total doses were 50.4 Gy to 70 Gy with a median of 60 Gy (50.4 Gy in 7, 59.4 to 61.2 Gy in 51, 66 to 70 Gy in 12). Results: The follow up time ranged from 3 to146 months with a median of 36 months. The 2-years and 5-years crude survival rates were 95.7%, 88.3% in M cases and 89.6%, 78.3% in SM cases, respectively (P Z 0.769). The 2-years and 5-years recurrence-free survival rate were 89.4%, 82.5% in M cases and 83.0%, 52.0% in the SM cases, respectively. The SM cancer had been frequently recurred after 2 years. There were 20 recurrent cases, and 13 of them recurrent within radiation field, 1 recurred from field margin, 1 recurred in out of the field, 4 recurred in lymph node and 1 recurred in lung. The 9 of 13 in-field recurrences were salvaged by endoscopic resection, 8 of them were successfully salvaged, but 1 needed radical surgery. The 3 of 4 lymph nodes recurrence salvaged by radiation therapy. The one case of lung metastasis was successfully salvaged by video assisted thoracic surgery. Conclusion: There were few out-of-field recurrences and they were salvaged radiation therapy. The in-field recurrences were salvaged by endoscopic resection. Therefore, involved field radiation therapy seems to be a good treatment option for patients with comorbidities and old age. However, all lymph node recurrences occurred after 3 years, careful longterm follow-up must be necessary.

The role of stereotactic body radiotherapy in hepatocellular carcinoma: guidelines and evidences

“…The results showed about 80% LC and 23%-69% 2-year OS. TACE plus SBRT was associated with superior OS, LC, and PFS than TACE alone, and higher OS and similar LC compared with SBRT alone in ≥ 5 cm HCCs 46 , 50 , 53 , 57 . However, SBRT combined with TACE was not associated with improved OS in <5 cm tumors compared with TACE alone 51 .…”